What is known about cardiovascular diseases among seafarers: A systematic scoping review and quality assessment.

BACKGROUND: Seafarers are at an increased risk of developing cardiovascular diseases (CVDs), potentially due to a stressful working environment and behavioral risk factors. To develop better prevention strategies, it is important to elucidate the extent of this risk. Therefore, we conducted a systematic literature review on CVD in seafarers. METHOD: We conducted systematic searches in five databases. All studies investigating CVDs among occupational seafarers, published in articles or conference papers, were eligible for inclusion. The identified records were screened and reviewed by two independent researchers, who also evaluated the methodological quality of the included studies. RESULTS: Three thousand nine hundred and seventeen records qualified for screening, and 55 were eligible for inclusion. Most of the studies were observational, including cohort, frequency, incidence or prevalence studies, and review of case records. Around half were assessed at risk of biased findings. Participants in the studies were primarily from North America or the European continent and work onboard transportation vessels. Many studies investigated CVDs as a cause of death, focusing on conditions such as CVD, ischemic heart disease, and myocardial infarction. Frequency of CVD conditions varied but indicate that seafarers face a greater risk compared to the reference populations or control groups. Environmental factors were mainly investigated as risk factors. CONCLUSION: Our results indicate a higher risk of CVDs among seafarers compared to reference or control groups. However, due to the variable quality of the evidence, well-designed studies are needed to establish the causes of cardiovascular mortality and morbidity in seafarers and to investigate behavioral aspects of cardiovascular risk.

Is physical and psychological work stress associated with fatigue in Danish ferry ship employees?

BACKGROUND: Fatigue is a recognised risk factor for safety in seafaring. While always dangerous, fatigue in ferry shipping is especially hazardous as it may jeopardise passengers' safety. To counteract fatigue, knowledge on its determinants is important. Little, however, is known on the influence from physical and psychosocial work environment factors within ferry shipping. The aim of the study was to investigate the association between work stress in terms of physical stressors, perceived job demands and job control and different dimensions of fatigue among ferry ship employees and to test whether a potential effect of work stress was mediated by sleep satisfaction. MATERIALS AND METHODS: The design was cross-sectional. 193 respondents answered to a self-administered questionnaire including standardised scales, i.e. the Swedish Occupational Fatigue Inventory and the Copenhagen Psychosocial Questionnaire for job demands and control. The association of risk factors with fatigue was determined using hierarchical multiple linear regression analyses. RESULTS: Physical work stressors were positively associated with only one of five fatigue subscales: lack of energy. Higher levels of demands were related to more lack of energy, lack of motivation, physical exertion and sleepiness, while more control was related to lesser lack of energy, lack of motivation and sleepiness. No demand-control interaction was found. Effects of demand and control were partly mediated by sleep satisfaction. CONCLUSIONS: Although limited by its cross-sectional design this study provides support for the independent relevance of demands and control for employee fatigue in ferry shipping and for a mediating role of sleep satisfaction.

Fatigue in ferry shipping employees: the role of work-family conflict and supervisor support.

BACKGROUND: Fatigue is a concern in ferry shipping as it has a negative impact on crew members health and plays a major role in marine incidents and accidents. Research within land-based occupational settings has found that work-family conflict is an important risk factor for fatigue and that support from leaders constitutes a possible resource with the potential to buffer a negative impact from work-family conflict. Though, the working conditions of ferry shipping are likely to interfere with employee's family life those two factors have received little attention in research on seafarers' health. Therefore, the aim of this study was to investigate the direct associations between work-family conflict as well as leaders' support with fatigue in employees of the Danish ferry shipping industry. Further, the study aimed at testing whether support could buffer potential detrimental associations between work-family conflict and fatigue. METHODS: The study design was cross-sectional, and 193 respondents answered to a self-administered questionnaire. Fatigue was measured with the Swedish Occupational Fatigue Inventory. Perceived work-family conflict and perceived supervisor support were assessed with two subscales from the Copenhagen Psychosocial Questionnaire. The association of potential risk factors with fatigue was determined using hierarchical multiple linear regression analyses. RESULTS: After controlling for confounding, work-family conflict was found to be positively associated with four of the five subdimensions of fatigue; lack of energy, physical discomfort, lack of motivation and sleepiness, while more support from supervisors was related to less lack of energy, physical exhaustion and lack of motivation. Further, supervisor support was found to moderate the effect from work-family conflict on the physical subdimensions of fatigue. CONCLUSION: Although restricted by its cross-sectional design and a limited sample, this study provides support for the independent relevance of work family conflict and support from nearest superior for employee fatigue in ferry shipping. Further, there was evidence for a moderating role of such support on the negative impact of work-family conflict on the physical aspects of fatigue. Shipping companies may consider commencing initiatives which reduce conflicts between family life and work obligations, and that leader support may be a relevant component in such initiatives.

Determinants of seafarers' fatigue: a systematic review and quality assessment.

PURPOSE: Fatigue jeopardizes seafarer's health and safety. Thus, knowledge on determinants of fatigue is of great importance to facilitate its prevention. However, a systematic analysis and quality assessment of all empirical evidence specifically for fatigue are still lacking. The aim of the present article was therefore to systematically detect, analyze and assess the quality of this evidence. METHODS: Systematic searches in ten databases were performed. Searches considered articles published in scholarly journals from 1980 to April 15, 2016. Nineteen out of 98 eligible studies were included in the review. The main reason for exclusion was fatigue not being the outcome variable. RESULTS: Most evidence was available for work time-related factors suggesting that working nights was most fatiguing, that fatigue levels were higher toward the end of watch or shift, and that the 6-h on-6-h off watch system was the most fatiguing. Specific work demands and particularly the psychosocial work environment have received little attention, but preliminary evidence suggests that stress may be an important factor. A majority of 12 studies were evaluated as potentially having a high risk of bias. CONCLUSIONS: Realistic countermeasures ought to be established, e.g., in terms of shared or split night shifts. As internal as well as external validity of many study findings was limited, the range of factors investigated was insufficient and few studies investigated more complex interactions between different factors, knowledge derived from studies of high methodological quality investigating different factors, including psychosocial work environments, are needed to support future preventive programs.